AB1199 THE ROLE OF THORACOLUMBAR FASCIA ULTRASOUND IN LOW BACK PAIN - IMPLICATION FOR GUIDED DRY NEEDLING
Authors: R. Bubnov, L. Kalika
Journal: Annals of the Rheumatic Diseases (2022)

Background Dry needling under ultrasound guidance (DN-US) is a crucial therapeutic for treatment myofascial pain [1], restore muscle function and motion [2], is among priotized methods for treatment low back pain (LBP), can be effective in rheumatic diseases. The definition `myo-fascial` calls for searching trigger points (TrPs) in fascia to improve the treatment effectiveness [3]. Ultrasound examination and guided dry needling can help understanding the role of the thoracolumbar fascia (TLF), its layers function and role in development of low back pain. Objectives Aim was to evaluate the relevance of fascial ultrasound and guided dry needling in low back pain in particular for thoracolumbar fascia (TLF). Methods We included 32 patients (20 females, 21-63 years old) with myofascial low back pain, postural imbalance; did DN-US protocol according to R. Bubnov [1]: muscle TrPs were identified, fine (28G) steel needle DN-US was applied. Additionally considered fascial structures for detecting areas of abnormalities (hypervascularity, heterogeinity, hypomotility, adhesions) aka `trigger points`. We did separate re-evaluating after stage of fascia and muscle needling. Results In all patients movement restored and pain decreased after muscles DN; in 24 patients additionally we detected changes in the major fascial points as follows: TLF, its layers (thickness increased up to 5-10 mm, local and diffuse calcification), sacroiliac joint (SIJ); and did successful DN-US to affected areas (increased thickness and stiffness according to SWE). During procedure we revealed places of stiff areas in fascia (TrPs), did precise dry needling to place the top of needle in the affected area in fascia. The strong `needle grasp`, low level of sensation during needling, local twitch response was not seen in fascia. TFL TrPs were associated with quadratus lumborum muscle. We noted fair improvement of motion in lumbar level after TFL needling alone, decreased hyperechoic lamina to 2-4 mm after DN. We detected higher rates of motility, improvement postural balance and pain decrease, fewer sessions needed in patients after extensive protocol. Conclusion Fascia dry needling is accessible and effective method for myo-fascial low back pain treatment, can provide additional mechanical benefit and help to maintain treatment effect. Affected fascia can be considered as relevant TrPs, specific ultrasound symptoms should be validated. References [1]Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13. [2]Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949 [3]Bubnov R, Kalika L. FASCIAL ULTRASOUND: THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN, POSTURAL IMBALANCE. Annals of the Rheumatic Diseases 2021;80:924-925. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3843 Disclosure of Interests None declared